POS0053 RHEUMATOID ARTHRITIS AND THE RISK OF COVID-19 DIAGNOSIS, HOSPITALISATION AND DEATH: A POPULATION-BASED MULTI-STATE COHORT ANALYSIS INCLUDING 5,586,565 PEOPLE IN CATALONIA, SPAIN

Background:

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is of particular concern for people with rheumatoid arthritis (RA), with concerns that these people may be at higher risk and have poorer outcomes. However, at present the implications of COVID-19 for people with RA remain poorly understood.

Objectives:

To investigate the associations between rheumatoid arthritis and the risk of COVID-19 diagnosis, hospitalisation with COVID-19 and COVID-19-related death.

Methods:

A population-based cohort study including all individuals registered in the Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering over 80% of the population of Catalonia, Spain, and was linked to region-wide SARS-CoV-2 PCR testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19 and deaths with COVID-19 were identified as study outcomes between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition, adjusted for age and sex.

Results:

A total of 5,586,565 individuals were identified in SIDIAP as of the 1st March 2020, of which 16,344 had RA. RA patients were median (IQR) 63 years (52.0, 74.0) and the majority (n=11,727, 71.8%) were female. Having RA was positively associated with being diagnosed with COVID-19 (adjusted HR 1.14 (1.03 to 1.28)), with hospitalisation with COVID-19 (HR 1.66 (1.35 to 2.04)). However, we did not find an association between RA status and the risk of worsening from outpatient diagnosis to hospitalization or death, or from hospitalization to death (see Table 1).

Table 1.

Estimated hazard ratios, adjusted for age and gender, for individuals with rheumatoid arthritis

TransitionStudy population (RA), nTotal events (RA), nHazard Ratios(95% Confidence Intervals)From general population to diagnosed with COVID-195,586,565 (16,344)88,396 (324)1.14 (1.03 to 1.28)From general population to hospitalised with COVID-195,586,565 (16,344)10,143 (90)1.66 (1.35 to 2.04)From diagnosed with COVID-19 to hospitalised with COVID-1988,396 (324)5,946 (30)0.95 (0.66 to 1.36)From diagnosed with COVID-19 to death88,396 (324)2,295 (16)0.96 (0.58 to 1.56)From hospitalised with COVID-19 to death16,089 (120)2,602 (27)1.13 (0.77 to 1.64)

Conclusion:

To our knowledge, this is the largest study performed to date looking at COVID-19 outcomes in RA patients. Individuals with RA were found to have an increased risk of COVID-19 diagnosis and hospitalisation with COVID-19, compared to the general population. Further research is needed to address factors associated with this including the presence of other co-morbidities, underlying RA disease activity and the use of immunosuppressive medications.

Disclosure of Interests:

Arani Vivekanantham: None declared, Edward Burn: None declared, Sergio Fernandez-Bertolin: None declared, Maria Aragon: None declared, Talita Duarte-Salles: None declared, Daniel Prieto-Alhambra Grant/research support from: Dr. Prieto-Alhambra reports grants and other from AMGEN, grants, non-financial support and other from UCB Biopharma, grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organised by DPA’s department and open for external participants.

Incidence and Risk of Pneumococcal Pneumonia in Adults with Distinct Underlying Medical Conditions: A Population-Based Study

PURPOSE

This study investigated the incidence of pneumococcal pneumonia requiring hospitalisation among middle-aged and older adults with and without specific underlying medical conditions, evaluating the influence of these conditions in the risk of developing pneumonia.

METHODS

Population-based prospective cohort study included 2,025,730 individuals ≥ 50 years around Catalonia, Spain. The Catalonian information system for the development of research in primary care (SIDIAP) was used to establish baseline characteristics of the cohort (comorbidities and underlying medical conditions). Hospitalisations from pneumococcal pneumonia occurred among cohort members between 01/01/2015 and 31/12/2015 were collected from hospital discharge codes of 68 reference Catalonian hospitals. Cox regression was used to estimate the association between baseline conditions and the risk of developing pneumonia.

RESULTS

Global incidence rate (IR) of hospitalised pneumococcal pneumonia was 82.8 cases per 100,000 persons-year. Maximum IRs (per 100,000 persons-year) emerged among persons with haematological neoplasia (837.4), immunodeficiency (709.2), HIV infection (474.7), severe renal disease (407.5) and chronic pulmonary disease (305.7). In the multivariable analyses, apart from increasing age, HIV infection (hazard ratio [HR] 6.78), haematological neoplasia (HR 6.30), prior all-cause pneumonia (HR 5.27), immunodeficiency (HR 4.57) and chronic pulmonary disease (HR 2.89) were the conditions most strongly associated with an increasing risk. Pneumococcal vaccination did not emerge associated with a reduced risk in our study population (nor PPsV23 neither PCV13).

CONCLUSION

Old age, immunocompromising conditions and chronic pulmonary/respiratory disease are major risk factors for pneumococcal pneumonia in adults. Our data underline the need for better prevention strategies in these persons.

Prevalence of high, medium and low-risk medical conditions for pneumococcal vaccination in Catalonian middle-aged and older adults: a population-based study

Background

Updated population-based data on the frequency and distribution of risk factors for pneumococcal disease is scarce. This study investigated the prevalence of distinct comorbidities and underlying risk conditions related to an increasing risk of pneumococcal disease among Catalonian middle-aged and older adults.

Methods

Cross-sectional population-based study including 2,033,465 individuals aged 50 years or older registered at 01/01/2015 in the Catalonian Health Institute (Catalonia, Spain). The clinical research database of the Information System for the Development of Research in Primary Care (SIDIAP database) was used to identify high-risk (asplenia and/or immunocompromising conditions) and other increased-risk conditions (chronic pulmonary, cardiac or liver disease, diabetes mellitus, alcoholism and/or smoking) among study subjects.

Results

Globally, 980,310 (48.2%) of the 2,033,465 study population had at least one risk condition of suffering pneumococcal disease (55.4% in men vs 42.0% in women, p < 0.001; 41.7% in people 50–64 years vs 54.7% in persons 65 years or older, p < 0.001). An amount of 176,600 individuals (8.7%) had high-risk conditions (basically immunocompromising conditions). On the other hand, 803,710 persons (39.5%) had one or more other risk conditions. In fact, 212,255 (10.4%) had chronic pulmonary diseases, 248,377 (12.2%) cardiac disease, 41,734 (2.1%) liver disease, 341,535 (16.8%) diabetes mellitus, 58,781 (2.9%) alcoholism and 317,558 (15.6%) were smokers.

Conclusion

In our setting, approximately 50 % of overall persons 50 years or older may be considered at-risk population for pneumococcal disease (almost 10 % have high-risk conditions and 40 % have other risk conditions).